Rising health care costs and surprise hospital bills often weigh most heavily on women, who must navigate confusing billing and insurance rules to take care of themselves and their families.
Jun 04, 2019Menopause & Aging Well
By Tamar Thompson, Chair, HealthyWomen Board of Directors
Marketers know that when it comes to purchasing power, women generally make 80 percent of the decisions for their families. Who hasn't spent an hour or more going down a rabbit hole of product reviews and price comparisons in an attempt to find the "right" product?
Now, think about trying that with health care. It's almost an impossibility.
Too often we lack the information necessary to make the right health care choices for ourselves and our families. In looking for quality and costs savings, many times we are faced with barriers to getting the information we need.
As someone who has spent more than 25 years working in the health care sector, I am very familiar with the administrative burden and challenges of the U.S. health care system.
Even so, my unique experience and knowledge did not prevent me from receiving my own surprise medical bills after having a planned medical procedure. The anesthesiologist who treated me was out of my insurance network and despite the countless number of forms and releases I had to sign on the day of the surgery (prior to receiving anesthesia, of course), no one said, "Oh, by the way, although this hospital is in network and so is your OB/GYN, the anesthesiologist is not, so be prepared to get a bill for an extra $3,000 for his care."
In this case, fortunately for me, I am a certified medical coder and work in health policy. Once I received the bill, I contacted my insurance provider and asked them to waive the out-of-network fees. And after a transfer to the customer service manager and maybe a threat to contact the state insurance department, the charges were removed. And while most people would not have done what I did or have known it was an option, the point is that they shouldn't have to.
That is why at HealthyWomen, we are working to increase awareness of the health care costs burden on women—and to find ways to empower women through knowledge.
Lack of access due to insufficient coverage is one of the most significant factors impacting women's health care burden; however, it is not the only one. Billing practices, out-of-pocket costs and provider network adequacy and availability are all factors that help shape the patient experience for women. I want women to be armed with as much information as possible before making health care choices for themselves and their families.
Education alone will not solve all the challenges in our country's health care system, but it is a crucial place to start.
Three Key Things to Know About the Cost of Care
Always begin with your health insurance provider. Contact your insurance company to learn about your benefits, your deductibles and any limitations of your plan. Your insurance company will send out a manual every year. It can be confusing and complex, but there is information in the manual that you need to know, whether you are the patient or the caregiver.
Ask three important questions. First, find out if the medical issue you are being treated for is covered by your plan. Next, find out what the deductibles, copayments or coinsurance fees are for the medical service or procedure. Also, if the procedure is scheduled during the first quarter of the new year, make sure that your coverage did not change. Remember that each year, health plans offer open enrollment in October. This is the only time of year that you are allowed to change your insurance coverage (unless a life event such as birth, marriage, divorce or death occurs).
Do not be afraid to talk to or challenge your provider. There is a reason that it is called "shared decision making." Yes, your health care professionals understand the services they provide, but only you can understand what you or your family is going through. Don't be afraid to ask questions about why a particular test is recommended, ask for a referral to a specialist or ask if your care plan includes access to innovative treatment options. The best way to ensure that you and your family are receiving the best care possible, is to ask for it!
The Future for HealthyWomen
Accessible, quality medical care and information about how to navigate the system bring us closer to health care equity for women and their families. That's why at HealthyWomen we provide accurate information, education and resources for women's empowerment.
More transparency in health care costs and quality will help women gain access to the knowledge needed to choose to be HealthiHer. Indeed, narrowing the gender equity gap must include equipping women with the knowledge and ability to be effective health care CEOs for themselves and their families.
Because if there's one lesson I've learned in my 25 years in the health care industry, it's that when we bridge the equity gap for women, we all win.
Tamar Thompson has served on the board of directors for HealthyWomen for a decade and as chair of the board since 2017.She is also head of Federal Executive Branch Strategy and State Government Affairs at Bristol-Myers Squibb Company.